American Healthcare Accreditation
In the United States, most hospitals are accredited through an organization that is known as the Joint Commission. Joint Commission accreditation holds a significant stake within the healthcare system in that it controls Medicaid reimbursements. Joint Commission is a nonprofit organization, operated by volunteers. This is the aspiration of the men and women of Joint Commission: Their mission is "To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.” (4)
The organization of Joint Commission came from humble beginnings when Earnest Codman began to promote reforms in hospitals to be compensated financially based on the quality of performance outcome in patient care. Thus, the American College of Surgeons Hospital Standardization Program was born, being the first healthcare quality entity to be wide spread across the nation.
The way that Joint Commission works is that they have a three year cycle in which hospitals are inspected in intervals to gain Joint Commission’s accreditation. During this time, the hospital will be inspected to see if it meets all the requirements of accomplishing compliance with applicable standards. When a hospital does meet their demands, they will be awarded accreditation.
The unique part of Joint Commission’s inspection is that their surveys are surprised and unannounced. As such, hospitals are encouraged to be in top performance in order to avoid losing their accreditation. This has the effect of improving consistency for performance of hospitals that receives accreditation from Joint Commission. Another part about their accreditation is that it is mainly on a pass/fail basis, where the findings of the surveyor is not published and the public will only know whether the hospital was able to acquire their accreditation or not.
As of today, Joint Commission has expanded into the Joint Commission International, where they are still operating as a nonprofit organization with the goal and mission to improve patient quality care worldwide. They extended their influence and offer to help improve the quality of hospitals and enhance patient safety across the globe.
Despite the fact that Joint Commission is the significant portion of American Hospital accreditation, it is not a monopoly and that many alternatives do exist, but not as to the same extent. The fact that Joint Commission is the standard of how the U.S. government decides on which hospital to approve for Medicaid reimbursement has significant influence of the accreditation market.
An example of an alternative accreditation to Joint Commission which is recognized nationwide is the Healthcare Facilities Accreditation Program, which was founded in 1943, making the organization older than Joint Commission. The organization was quickly able to gain recognition, and by the mid 1960s, the United States Congress decided that hospitals being accredited by this group were qualified to participate in the Medicare and Medicaid Programs. Their organizational goals are not so different from Joint Commission in that they desire to help healthcare facilities which are under their accreditation deliver high quality patient care by means of meeting the standards set by the organization. They are committed to continuous improvement through the constant review and streamlining of their survey processes.
International Healthcare Accreditation
The desire for quality within the medical community is not exclusive to America. This fact factored along with growing trend towards globalization and medical tourism, there is significant interests in international accreditation of hospitals. Joint Commission is one of those examples, having already grown beyond the borders of America. They have established themselves across over 60 other countries around the world. This trend is more prevalent within the developed world where growing consumerism culture is making the patients, otherwise known as the consumers, more conscious of the care that they are given, or in the other terms, services given. As such, quality assurance is a critical part of the value chain of a healthcare provider and is not unique to the United States.
Healthcare delivery has always been defined by three distinct pillars. They are availability, cost, and quality. In much of the European Union, availability and cost of their healthcare systems has been relatively well managed. Thus, many Europeans are now looking towards quality as the next challenge to tame. This is evident as the Office of Public Health and Social Affairs stated, “... patients have ever-greater expectations of what health systems ought to deliver,” although there has been a “... continuous rise in costs of services determined by scientific and technological innovation.”(2) Healthcare being available in many countries around the world, it is imperative for these institutions to also deliver on quality. This is not only serving more people but also saving more people in the end.
Another issue that has lead to greater interest in international accreditation has been more closely tied into the new trend of Global Healthcare. As our world begins to get smaller and traveling becomes more and more easy, the law of economics and sociology only dictates that humans will ultimately seek out the sources of highest output for the lowest cost. And in this case, healthcare is no exception to this rule. Thus, we see more and more Americans traveling overseas for Medical Tourism and vice versa. Many people around the world also travel to the United States for treatment due to long established specialty. It is no easy decision for any individual, however, for such a trip takes time and commitment. We are seeing a new generation of patients who will do much greater research to find the best solutions to their problems. In order for overseas hospitals to get the patients there for medical tourism, they must have two advantages which will ultimately prompt the patient to travel to them. In this instance, the two factors include cost and quality. With the deficit in healthcare ever increasing in the United States, healthcare affordability has become a much heated issue. This factored in with the recent economic down turn, many people in the United States remain uninsured due to the costs issue. An attractive option will present to this group through the address of their problems with money. These hospitals will a lot of times be able to deliver care in a much more efficient manner due to cheaper infrastructure and support cost, thus the savings are given back to the customer. When the entire operation cost results in a price tag cheaper than what the patient would have to pay for in deductibles, this is usually good enough bait to lure in a customer. However, cost itself is not good enough to attract a customer. The question of quality has to be addressed, as not many people would be willing to take risks to their lives all in the name of costs alone. This is where international accreditation comes in. They can assure to the customers around the world that the hospitals standards within other nations are the same, if not better, than the quality of hospitals they have at home. With these two issues addressed, often times many people will then be willing travel to get healthcare at Great Value. Quality without addressing would not work simply because most consumers cannot afford them and will be seen as an activity that is overpriced. On the other hand, cost without quality will also be unacceptable, for patients will only be gambling their lives to save money. Only with the two pillars addressed will patients be willing to travel, and with international accreditation, many patients across the globe have a quality standard of these Medical Tourist Hospitals that they can relate to and are familiar with since they are the same accreditation at home.
So what is international accreditation exactly? In many developed nations around the world, hospital accreditation has been in the making internally for time now. An example would be Joint Commission within the United States. As such, many older nations have naturally become the guru of quality in the healthcare industry, setting the bar for others to follow. For an example, recently, China has begun on their set of healthcare reforms. When it came to the topic of quality, they used the United States accreditation standards as a precedence for which they can set and work with. (3) As such, accreditation standards used here in the United States are being used by foreign countries to access their own healthcare systems. Therefore, many new prosperous nations seek the services of major international healthcare accreditation group in order to bring their own hospitals up to the global standards. Aside from improvement of quality service to their own citizens among these countries that have seek international accreditation, they also seek the accreditation on the basis of quality assurance to medical tourists, hoping to market themselves better in the process and attract more medical tourists to their facilities. This will secure their competitive advantage to better deliver care as well. Many foreign governments are getting into the game also due to the fact that medical tourism is becoming a huge industry among these countries bringing in revenue and growth to their economy in the process. As such, international accreditation will enable them to better market themselves to foreign citizens and attract them thus fueling the growth of their own healthcare industries within their perspective borders.
International Healthcare Accreditation Agencies
As a result of increasing demand of accreditation, the Trent Accreditation Scheme came into the expansionist policy that it is right now. Based in the United Kingdom, it was the accreditation force behind much of the hospital systems within the nation and for her colonies. As a result, as England began losing control over much of their former colonies, the Trent Accreditation Scheme still remained as a huge player in many of those countries, including former colonies of the crown in Asia specifically Hong Kong. As such, the organization was pushed into the international stage.
Joint Commission International is a group that we are all familiar with. Recently, it has expanded to well over 60 other countries around the world, and through it international accreditation activities in many countries, it would bring an income to the parent company of Joint Commission which is based in the United States. This would further show how high the demand is for hospitals around the world to be recognized as on par with American hospitals thus being able to compete for patients to enter into their market.
The International Society for Quality in Health Care is an accreditation organization that operates as an umbrella organization for its accreditation groups across the globe. Being based in Ireland, the group operates as primarily a consulting group that would further the quality of healthcare of the hospitals that they are working with. (5)
The Government as a Healthcare Quality Control Entity
With such significant profound effect on the population of any society that health care have, government is definitely a significantly important stake holder. As such, a lot of times, government would demand quality from healthcare providers so that the patients going through those hospitals will get better and not worse and the way that government influence healthcare quality is by means of laws, legislations and rewarding of reimbursements.
An example of legislation that has an effect on quality care and patient safety is the Patient Safety and Quality Improvement Act that was passed in 2005. (5) Through this bill, it established a system of patient safety organizations in order to encourage the discussion of case complications and how to avoid them.
The legislation is attributed as a response to the publication of “To Err is Human” by the Institute of Medicine 1999 report. Within this report it points to the staggering numbers that medical errors have on people. The report’s finding suggests that most errors are not the result of human error, but as the result of error within the process, an error that can be fixed by administrative diligence. Therefore, the report recommend that administration on all levels work together to improve safety making it harder for all levels within the system to make a mistake while making it easier to avoid preventable errors.
Other initiative including bargaining power that the government has in the forms of reimbursements control where hospitals have to be eligible for them, and as a result, giving rise to powers such as Joint Commission, where the government will not qualify a hospital unless they have accreditation from Joint Commission or one of their major competitive alternatives.
BIBLIOGRAPHY
1. Raik, Eva. "Bmj.com Rapid Responses for Braithwaite, 323 (7310) 443-446." Bmj.com:. Aged Care Accreditation in Australia, 7 Nov. 2001. Web. 02 July 2010.
2. "Contribution to the Reflection Process for a New EU Health Strategy." Venice Italy: Regional Health and Social Department, Web. 06 July 2010.
3. Lipson, Roberta. "Investing in China's Hospitals -- CBR Nov-Dec 2004." The China Business Review: The Magazine of the US-China Business Council. Web. 03 July 2010.
4. "Facts about The Joint Commission | Joint Commission." The Joint Commission. Joint Commission. Web. 13 Nov. 2009.
5. "International Society for Quality in Health Care Inc, Accreditation." International Society for Quality in Health Care Ltd. Web. 01 Aug. 2010.
6. Six Sigma Job: Master Black Belt/Six Sigma Consultant- Telecommut." I Six Sigma Job Shop - Six Sigma Jobs. Web. 02 Aug. 2010.
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